<%@ page language="java" import="java.util.*" pageEncoding="UTF-8"%>
<%
String path = request.getContextPath();
String basePath = request.getScheme()+"://"+request.getServerName()+":"+request.getServerPort()+path+"/";
%>


<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
  <head>
    <base href="<%=basePath%>">
    
    <title>My JSP 'reimbursementr_add.jsp' starting page</title>
    
	<meta http-equiv="pragma" content="no-cache">
	<meta http-equiv="cache-control" content="no-cache">
	<meta http-equiv="expires" content="0">    
	<meta http-equiv="keywords" content="keyword1,keyword2,keyword3">
	<meta http-equiv="description" content="This is my page">
	<link rel="stylesheet" href="css/pintuer.css">
	<link rel="stylesheet" href="css/admin.css">
	<link rel="shortcut icon" href="images/logo.jpg">
	<script src="js/jquery.js"></script>
	<script src="js/pintuer.js"></script>

  </head>
  
  <body>
     <div class="panel admin-panel">
		<div class="panel-head" id="add">
			<strong><span class="icon-pencil-square-o"></span>登记参合信息</strong>
		</div>
		<div class="body-content">
			<form method="post" class="form-x"
				action="<%=basePath%>/jilu_sava.action" method="post">
				<div class="form-group">
					<div class="label">
						<label>报销编号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50"  value="" 
							name="reim.reimid"  />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>参合证号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50"  value="${comm.comcode}" 
							name="reim.comcode" data-validate="required:数据必填项" readonly="readonly"/>
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>身份证号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.perscode}"
							name="reim.perscode" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>慢性病证编号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value=""
							name="reim.chrdissynid" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>慢性病名称：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value=""
							name="reim.illname" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>姓名：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.name}"
							name="reim.name" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>性别：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.sex}"
							name="reim.sex" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>年龄：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.age}"
							name="reim.age" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>地址：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.address}"
							name="reim.address" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>联系方式：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.contact}"
							name="reim.contact" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>参合时间：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="${comm.comtime}"
							name="reim.comtime" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				
				<div class="form-group">
					<div class="label">
						<label>报销金额：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value=""
							name="reim.reimlimit" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>报销时间：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value=""
							name="reim.reimtime" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>报销发票号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value=""
							name="reim.reiminvocode" data-validate="required:数据必填项" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label></label>
					</div>
					<div class="field">
						<button class="button bg-main icon-check-square-o" type="submit">
							提交</button>
					</div>
				</div>
			</form>
		</div>
	</div>
	<script type="text/javascript">
            function limitInput(o){
                var value=o.value;
                var min=1;
                var max=35000;
                if(parseInt(value)<min||parseInt(value)>max){
                    alert('当前用户报销比例已超本年封顶线');
                    o.value='';
                }
            }
        </script>
  </body>
</html>
